BROWN TUMORS OF GNATHIC BONES AS THE FIRST MANIFESTATION OF PRIMARY HYPERPARATHYROIDISM

Abstract

We report a case of exuberant brown tumors affecting the gnathic bones as the first manifestation of primary hyperparathyroidism (PHPT). A 34-year-old female patient presented with midfacial asymmetry caused by an 8- × 4-cm painful and bleeding swelling in the left posterior maxilla, showing progressive growth for the last 2 months. A 4- x 2-cm normal-colored swelling was also detected in the right body of the mandible. Medical history included hypertension, fever, and weight loss. Panoramic radiography showed multilocular radiolucencies, overall thinning of the inferior border of the mandible, and loss of the lamina dura. Incisional biopsy revealed central giant cell lesions, which were diagnosed as brown tumors of PHPT. High values of parathormone and alkaline phosphate were detected and microscopic diagnosis of parathyroid adenoma was established after parathyroidectomy. The patient received calcium and calcitriol supplementation. Both lesions decreased partially after 2 years of follow-up, with aesthetic surgery being planned. We report a case of exuberant brown tumors affecting the gnathic bones as the first manifestation of primary hyperparathyroidism (PHPT). A 34-year-old female patient presented with midfacial asymmetry caused by an 8- × 4-cm painful and bleeding swelling in the left posterior maxilla, showing progressive growth for the last 2 months. A 4- x 2-cm normal-colored swelling was also detected in the right body of the mandible. Medical history included hypertension, fever, and weight loss. Panoramic radiography showed multilocular radiolucencies, overall thinning of the inferior border of the mandible, and loss of the lamina dura. Incisional biopsy revealed central giant cell lesions, which were diagnosed as brown tumors of PHPT. High values of parathormone and alkaline phosphate were detected and microscopic diagnosis of parathyroid adenoma was established after parathyroidectomy. The patient received calcium and calcitriol supplementation. Both lesions decreased partially after 2 years of follow-up, with aesthetic surgery being planned.